Assessment of Biomarkers in Children to Help Parents Quit Tobacco

评估儿童生物标志物以帮助父母戒烟

基本信息

批准号：
10443876
负责人：
Jonathan P Winickoff
金额：
$ 33.06万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10443876
关键词：
Accounting Aerosols Biochemical Biological Markers Blood Blood specimen Cessation of life Child Child health care Childhood Clinical Clinical effectiveness Cotinine Counseling Data Disease Documentation Electronic Nicotine Delivery Systems Enrollment Exposure to Family Feedback Follow-Up Studies Future Health Benefit Health system Hemoglobin Home Household Intervention Lead Life Expectancy Link Measurement Measures Methods Morbidity - disease rate Nicotine Outcome Parents Patient Self-Report Pregnancy Outcome Prevalence Primary Health Care Professional counselor Provider Randomized Research Risk School-Age Population Services Smoke Smoker Support Groups Surveys System Testing Time Tobacco Tobacco Use Cessation Tobacco smoke Tobacco use Toxin Training United States Visit Well Child Visits Work arm compare effectiveness cost cost effective effectiveness testing environmental tobacco smoke exposure follow-up health care delivery improved innovation medically underserved member mortality next generation nicotine exposure nicotine replacement outreach pediatrician provider adherence quitline routine screening screening screening program secondary analysis smoking cessation tobacco abstinence tobacco cessation intervention tobacco control tobacco screening tobacco smoke exposure tobacco user uptake vaping young adult

项目摘要

ABSTRACT: Tobacco use is the single greatest preventable cause of morbidity and mortality in the United States, accounting for 480,000 deaths and $300 billion in attributable costs annually. One quarter of all smokers are seen at their child’s primary care office and may not have a primary care doctor of their own. When parents quit smoking, their life expectancy is increased by over 10 years, future tobacco-related poor pregnancy outcomes are avoided, children have a four-fold lower risk of becoming smokers, the family has more money for necessities, and children are less likely to suffer diseases caused by tobacco smoke exposure (TSE). Routinely delivered tobacco control assistance to parents in the pediatric setting would provide a major health benefit to the nation. Our previous systems change efforts using the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention to identify parents who smoke, deliver nicotine replacement therapy, and enroll them in the quitline have shown significant improvements in pediatric practice uptake and parent outcomes. However, the CEASE intervention has faced barriers, such as reliance on parental self-report of TSE, which underestimates childhood exposure, and variable provider adherence to delivering parental cessation assistance. Children who live with smokers are exposed to secondhand and thirdhand tobacco smoke, and potentially to aerosol from parents who use electronic nicotine delivery systems (ENDS). Routinely screening children’s blood for cotinine, a biomarker of nicotine exposure, could reliably identify children with TSE exposure. Extant lead screening programs, already part of pediatric healthcare delivery, provide an obvious, yet currently untapped opportunity to screen for cotinine at well-child visits. Routine cotinine measurement in children using blood already collected for lead testing can institutionalize management of TSE in a comparable fashion. Results from objective cotinine testing could be used to motivate both providers and parents to promote tobacco control and cessation activities. Our preliminary qualitative and quantitative work suggests this approach is feasible, acceptable, and effective. We hypothesize that providing cotinine biomarker results to pediatricians, personalized cotinine feedback to parents about their child’s toxin exposure, and offering support to all household tobacco users to quit tobacco use (Biomarker Informed Outreach (BIO)) when added to the CEASE intervention will increase delivery of tobacco cessation assistance, increase household cessation, reduce TSE in children, and be cost-effective. We propose a 2-arm RCT conducted in five pediatric practices, enrolling children and parents at the child’s 1-year well child visit. The enrolled subjects will be randomized to either CEASE+BIO or CEASE arms. To compare the effectiveness of CEASE+BIO vs. CEASE, we will follow-up with enrolled parents at the 2-year well child visit to assess parental quit rate and children’s TSE. Trial results could lead to universal documentation of TSE and trigger more effective tobacco cessation support for the group of young adult parents who live with, expose, and influence the next generation.

摘要：烟草使用是美国发病率和死亡率的最大可预防原因每年造成 48 万人死亡和 3,000 亿美元的损失。吸烟者在孩子的初级保健办公室就诊，可能没有自己的初级保健医生。当父母戒烟时，他们的预期寿命将增加10岁以上，未来与烟草相关的贫困避免了妊娠结果，儿童吸烟的风险降低了四倍，家庭成员购买必需品的钱更多，儿童患上因接触烟草烟雾而引起的疾病的可能性也较小（TSE）向儿科家长定期提供烟草控制援助将提供重大帮助。我们以前的系统通过“反对二手货的临床努力”改变了努力。烟雾暴露（CEASE）干预措施，以确定吸烟的父母，提供尼古丁替代疗法，并让他们加入戒烟热线，儿科实践的接受度和家长的接受度都有显着改善然而，CEASE 干预面临着障碍，例如依赖家长的自我报告。 TSE，低估了儿童时期的暴露程度，以及可变的提供者对提供父母的依从性戒烟援助。与吸烟者生活在一起的儿童接触二手和三手烟草。烟雾，并可能来自经常使用电子尼古丁输送系统 (ENDS) 的父母的气溶胶。对儿童血液中的可替宁（一种尼古丁暴露的生物标志物）进行筛查，可以可靠地识别儿童 TSE 暴露。现有的铅筛查计划已成为儿科医疗保健服务的一部分，可提供在儿童常规检查中筛查可替宁的明显但目前尚未开发的机会。使用已采集的血液进行铅检测可对儿童进行测量，可以将 TSE 管理制度化以类似的方式，客观的可替宁测试的结果可以用来激励提供者和家长促进烟草控制和戒烟活动。表明这种方法是可行的、可接受的且有效的。我们勇敢地提供可替宁生物标志物。向儿科医生提供结果，向家长提供有关孩子毒素暴露的个性化可替宁反馈，以及为所有家庭烟草使用者提供戒烟支持（生物标记知情外展 (BIO)）添加到 CEASE 干预措施中将增加提供戒烟援助，增加家庭我们建议在五个儿科中进行一项 2 组随机对照试验。实践，在孩子的 1 年儿童健康访视中登记儿童和家长。登记的受试者将是。随机分配至 CEASE+BIO 或 CEASE 组为了比较 CEASE+BIO 与 CEASE 的有效性，我们将在为期 2 年的儿童健康访视中对已登记的家长进行跟踪，以评估家长的戒烟率和孩子的戒烟率。 TSE 的试验结果可能会导致 TSE 的普遍记录并引发更有效的戒烟。支持与下一代一起生活、暴露并影响下一代的年轻成年父母。